Provider Demographics
NPI:1780775064
Name:CLOUTIER, MATTHEW BURTON (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BURTON
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WOODCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:252-367-1087
Mailing Address - Fax:
Practice Address - Street 1:2102 SW 20TH PLACE
Practice Address - Street 2:BLDG 100 US HEALTHWORKS
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-732-7518
Practice Address - Fax:352-732-0710
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22674225100000X
NCP10370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist